CDC

With the new PBS Frontline documentary Hunting the Nightmare Bacteria premiering this week, I hope that the American public is finally becoming aware of what many in the U.S. and around the world have seen coming for years.  I encourage readers to check out the film and the links available online through PBS. However, I feel ethically bound to issue a ‘trigger warning’ for those who do not want to view a child and young adult being ravaged by diabolical infections.

Are we ready for the post-antibiotic era?  Supposedly, we were all alerted last March when the CDC sounded an alarm – “Action needed now to halt spread of deadly bacteria” – but how many of us heard it?

We’re still in the dark when it comes to nightmare bacteria.  At this point, I’m less convinced that anyone is “hunting” these antibiotic-resistant bacteria and more convinced that these microorganisms are hunting us.  We need to be on the defensive, taking steps to protect ourselves, our loved ones, and our society.

Reading the PBS documentary’s link to “Eight Ways to Protect Yourself from Superbugs,” I found tips that are not new but are important reminders for public health.  I’m a big believer in their recommendation to question the necessity and effectiveness of all prescriptions of antibiotics (e.g., that they cannot cure viral illnesses).  That said,  I’m sad that we still need to teach people how to properly wash their hands, and I’m even more dismayed that we have to recommend that everyone asks their medical providers to wash their hands.  Unfortunately, promoting hand-washing is only a small improvement when proper drying methods are unavailable: studies continue to show that air hand dryers add more bacteria to clean hands.

In the documentary, Arjun Srinivasan, M.D., Associate Director of CDC, warns, “…the more antibiotics we put into people, we put into the environment, the more opportunities we create for these bacteria to become resistant….”  However, the environmental components – government funding for research and surveillance, public health policies, and medical norms – are not fully addressed by this film.  In addition, the causal link to meat and poultry policies/practices is completely absent.  As a medical sociologist, my critique of this documentary is that it spends a lot of time on horrific case studies and too little time on the structural and social causes, consequences, and solutions to this crisis.

For a more complete picture, see the CDC’s report with graphics that illustrate the dynamics of drug resistance.  I was stunned by chilling estimates: annually, antibiotic resistance will cause over 2 million Americans to become ill and will result in at least 23,000 deaths.  In the early years of the HIV/AIDS epidemic, activists rallied public support and political action with the message that “Silence Equals Death” – what message will wake up Americans to the realities of our new nightmare?

Last month, the CDC released a report that I’m going to pick on a little bit, though I’ve seen numerous researchers make similar faux pas in surveys I’ve taken and studies I’ve read.  The report, Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States, uses data from the 2006-2008 National Survey of Family Growth to summarize findings on these topics.  I’m just going to harp on a tiny bit of the survey design, because I think it’s illustrative of a broader point about how survey design can reflect and even shape attitudes about what is and isn’t a sex act, and what is and isn’t a sexual relationship.

Now, to be fair, the NSFG is primarily about addressing things like pregnancy, marriage, and STIs.  The portion of the survey that focuses on sexual acts includes same-sex partners but it’s still geared towards things like STI risk, and thus focuses on sex acts that have a high STI risk like penetration and oral sex.  But there’s still a big problem in the way it describes the possible sex acts for males and females.

Note: The portion below the cut may not be safe for work due to frank descriptions of sexual acts.

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In honor of April being STD Awareness Month, I devote this month’s column to a topic that remains near and dear to my heart (and my cervix): HPV, human papillomavirus.  So, it’s a great time to get yourself tested at your local STD testing location, or send an e-card to a loved one who could use a friendly reminder:

This month might have inspired some of you to consider vaccines that offer some protection against HPV: like Gardasil or Cervarix.*  However, don’t get too excited about Gardasil if you happen to be 27 years old (or older) and live in the U.S.  Earlier this month, the FDA decided against expanded the vaccine’s label use for ‘older’ women:

…the Limitations of Use and Effectiveness for GARDASIL was updated to state that GARDASIL has not been demonstrated to prevent HPV-related CIN 2/3 or worse in women older than 26 years of age.

However, as of Tuesday, ‘older’ Canadian women now have more options than their U.S. counterparts:

Merck announced that Health Canada has extended the indication of GARDASIL^® [Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Recombinant Vaccine] in women up to the age of 45. Merck’s HPV vaccine is now approved for girls and women nine through 45 years of age for the prevention of cervical cancer, vulvar and vaginal cancers, precancerous lesions and genital warts caused by the Human Papillomavirus (HPV) types 6, 11, 16, 18.

So, what’s the deal?  According to a Canadian women’s health expert, this is a good decision:

Whatever the reason, there’s a tendency for women to remain at risk of acquiring new HPV infections as they get older. Whether they are changing their social status or not, women should talk to their doctors about the HPV protection provided by the quadrivalent vaccine,” said Dr. Alex Ferenczy, Professor of Pathology and Obstetrics & Gynecology at McGill University.

If I’m correct in inferring that Dr. Ferenczy’s use of the phrase “social status” refers to a woman’s sexual partner/sexual relationship status, then are we to assume that U.S. women between the ages of 27 and 45 are in more stable sexual relationships than their Canadian counterparts?  I’ve yet to read a study that would support this conclusion.

So, as a U.S. woman who happens to be in this age group, I feel it only right to encourage my peers to ask their doctor about Gardasil, especially if they’re “changing their social status.”

For the boys and men out there, remember that the FDA approved Gardasil in October 2009 for protection against two types of HPV which cause genital warts in males ages 9-26.  Then, last December, the FDA approved of GARDASIL for the prevention of anal cancers caused by two different types of HPV in females and males 9-26 years old. 

However, once again, there appears to be possible age-discrimination: men over 26 years old, consider whether Gardasil might offer health benefits for you.

*Note to readers: I respect that many will decide that a vaccine is not right/healthy/safe for themselves or for their family members.  I highlighted the recent news about Gardasil because I believe that everyone deserves access to vaccine updates.  I’ll conclude by quoting myself:

I don’t know if the pro- and anti-vaccine folks will ever see eye to eye, but there’s absolutely nothing to lose and everything to gain by being pro-HPV-education.